BASIC RESEARCH IN SURGERY

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BASIC RESEARCH IN SURGERY

• Dr Divakar Shenoy
• Professor and H.O.D Surgery
• Father Muller Medical College

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Research

• U.S. Federal regulation defines research as a
  systematic investigation designed to develop or
  contribute to generalizable knowledge

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Poppers Falsification Theory

• Science begins with a prejudice (theory or
  hypothesis), progresses by proving that good
  ideas are wrong so that they can be replaced by
  better ones

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• Research is the foundation for all scientific
  achievements. But for research, the various
  causative factors, diagnostic tools and treatment
  modalities for various diseases would not have
  been found

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Evidence based medicine and research

• To administer a particular drug or to perform a
  operation there should be enough evidence to
  prove that the particular treatment is effective.
  first an animal experiment then human trial

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Sushruta Father of Indian Surgery
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Gerhard Henrik Armauer Hansen (1841-1912)
leprosy bacillus
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Louis Pasteur father of modern microbiology and
founder of pasteurisation
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Robert Koch discovered TB and coined Kochs
Postulates
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John Gregor Mendel Father of Modern genetics
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Madam Curie Radiotherapy
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Edward Jenner Small pox vaccine
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Sir Alexander Fleming discovered penicillin in
1928
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Joseph Lister Father of Antiseptic Surgery
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Hans Christian Barnard First heart transplant
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Tools of Surgical Research

• Observational studies
• Ecological studies
• Very useful. Here we compare population
  characteristics to find correlates of disease.
  For example compare the amount of dietary fat
  consumed in different countries with the
  incidence of breast cancer in those countries to
  see if there is any association. It is limited by
  unmeasured confounding

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• Case series
• Popular in surgery because they are easy to
  perform, require less resources, can be performed
  at a single center, provides a means for the
  surgeon to showcase personal skill and methods

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• Special exposure groups
• This is useful when the exposure or conditions
  derived there from may be of etiologic
  significance. For example, if you are interested
  in the effect of eating meat on a certain
  disease, then compare people who do not eat meat,
  e.g. Vegetarians (Buddhists, Adventists), to
  those who do

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• Migrant and secular studies
• Here we study people of similar origin, some of
  whom have migrated either voluntarily or
  forcefully (slave trade) to see whether the
  occurrence of disease varies across that
  population across the spectrum of migration

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• Case control
• In case control studies, we gather people who
  have the condition of interest and compare them
  over the same period of time with people who are
  similar to them but for the fact that they do not
  have the condition. It is relatively cheap, does
  nottake time but is troubled by problems of
  recall and selection bias

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• Cohort studies
• Expensive long term study of a group of people
  for occurrence of condition of interest among
  them over time. It is the best tool of
  observational research

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• Experimental studies
• Cell culture
• Here we grow cells in vitro and study exposure
  and the response of the cells
• Animal experiments
• We use animal models of diseases or create the
  condition of interest in the animal and study

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• Controlled trials
• The characteristics of this method are
  randomization and blinding. We allocate people by
  chance to an investigational and a placebo arm
  and compare their response to exposure of
  interest

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Animal experiment (requirements)

• Swiss albino rats, Guinea pigs, mice, rabbits and
  dogs
• Animal house
• Animal house keeper
• OT technitian
• Operating table, light and operating microscope
• Common surgical instruments

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Animal Experiment
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Tools of Surgical Research and Evidence-based
Medicine

• These tools have a hierarchy of value, but care
  must be exercised in applying judgment as this
  hierarchy is not strict
• Randomized double-blind controlled clinical
  trials are acknowledged as the most superior
  basis for evidence-based medicine, followed by
  the observational studies (cohortgtcase
  controlgtcase seriesgtecological studies), then
  animal and cell culture studies

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Tools of Surgical Research and Evidence-based
Medicine

• A study is only as good as the design,
  implementation and analysis
• Some conditions cannot be studied by experimental
  methods and inference must be drawn from
  observational studies

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Institutions of science

• Where science is done
• In degree awarding institutions
• In hospitals
• Laboratories
• Role of Scientific societies
• Are like the grand juries of science and conduct
  of scientists
• Role of journals and conferences
• Publications and peer review are the currency of
  science

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The rewards of science

• The sheer pleasure of finding things out
• Reward system and authority structure
• Academic promotion
• Various prizes and medals by different scientific
  organizations
• Endowed chair
• Election into National Academies
• Nobel Prize and similar level prizes in different
  disciplines
• Immortality

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• Let us remember that a slower progress in the
  conquest of disease would not threaten society,
  grievous as it is to those who deplore that
  particular disease be not conquered, but that
  society would indeed be threatened by the erosion
  of those moral values whose loss, possibly caused
  by too ruthless a pursuit of scientific progress,
  would make its most dazzling triumphs not worth
  having -Jonas